Endocrine Abstracts

Mesonephric adenocarcinoma (MA) is an uncommon gynecologic tumor that are thought to arise from embryonal remnants of the mesonephric ducts, also known as Wolffian ducts. Mesonephric-like adenocarcinoma (MLA), despite absence of Wolffian origin, have similar morphology and immunophenotype and exhibit molecular aberrations like MA. These tumors are generally negative for estrogen and progesterone receptor.

Case Report: An 83-year-old Spanish female was referred to our outpatient clinic of endocrinology to study hirsutism. She had a history of 4 uncomplicated pregnancies and experienced menopause at age 42 years. She had not taken hormone replacement therapy and she didn’t experience uterine bleeding. A drug history excluded anabolic steroid use or exposure to exogenous androgens. In the anamnesis she referred a recent-onset hirsutism, less than 3 months, without signs of virilization and constitutional syndrome with asthenia and anorexia. Ferriman-Gallwey score was not calculable by depilation of facial and body hair; it was only visible the presence of excess terminal hair growth in the abdomen. She had no stries. Laboratory testing revealed the following levels: total testosterone 4.46 ng/ml (normal range, <0.25), androstenedione >10 ng/ml (normal range, 0.3-3.3), 17-hydroxyprogesterone 17.80 ng/ml, dehydroepiandrosterone sulfate (DHEA-S) 183 mg/dl. Abdominopelvic CT revealed two tumors in the pelvis of 11.5x9 cm and 8.5x5.5 cm. The largest one had necrotic degeneration. No significant adenopathies where shown and adrenal glands were normal. A laparoscopic bilateral salpingo-oophorectomy was performed. Histopathology revealed two tumors of 13x11x7 cm, of 851 gr of weight, and another one of 9x8x2 cm. The first one was solid with gray-white solid areas associated with areas of necrosis with admixture of growth patterns (ductal and tubular), as well as intraluminal eosinophilic colloid-like material resembling mesonephric remnants, and atypical nuclear cells. No evidence of mesonephric remnants or endometriosis were observed. The other one was a fibrous fragment which included the other ovary and fallopian tube. There was no neoplastic infiltration of other tissues, and the peritoneal fluid was positive for malignancy. By immunohistochemistry, tumor cells were positive for GATA3, CD10 and androgen receptor and negative for calretinin, PAX8, estrogen and progesterone receptors, TTF1 and CDX2. The final diagnosis was MLA of the ovary pT2aNx (TNM, 8^a edic), FIGO IIA. After the surgery, testosterone level was <0.20, androstenedione <0.3 ng/ml, 17-hydroxyprogesterone 0.3 ng/ml and DHEAS 34.3 mg/dl.

Conclusion: Here we describe the first case of mesonephric-like adenocarcinoma of the ovary with positive androgen receptors